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Intro to 12-lead ECG

Faith Kelly

Created on July 17, 2024

the first 5 steps for 12-lead interpretation

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Transcript

The 12-Lead ECG: Steps 1- 5

Dr. Faith Kelly

Paper
Rate
Rhythm
Axis
Intervals

https://ecg.bidmc.harvard.edu/maven/dispcase.asp?rownum=4&ans=1&caseid=5

The standard paper speed is 25mm/sec and 10mm/mV "height"

Pro Tips

  • To bring out an atrial rhythm increase the gain to 20mm/mV
  • the width of the block = 5mm = .2 seconds = 200ms or "one big box"

Limb Lead Axis

Check your thumbs!
aVF
= normal axis
= Left axis
= Right axis
= extreme

Say it with me 300-150-100-75-60-50

  • Each "big box" is 200ms = 5 would be 1000ms or 60bpm
  • 300 / "big boxes" = bpm

>100 bpmRegular or irregular?

Normal Intervals

Big & Little Boxes

  • PR- 110-200ms
    • One "big box
  • QRS- 80-100ms
    • <3 "little boxes"
  • QT- ~350-450ms
    • < 1/2 of the R-R interval

Rate

  • >100 bpm = Tachycardia
  • 60-100 bpm "normal"
  • <60 bpm = Bradycardia

Left Axis

Right Axis

or

-30 to -90 degrees

->90 degrees

  1. Right Ventricular Hypertrophy
  2. Horizontal heart/normal varient
  3. Pulmonary Embolus/R heart strain
  4. Inferior MI
  5. Left Posterior Fascicular Block
  6. Secundum ASD*
  1. LBBB (left bundle branch block)
  2. Left Ventricular Hypertrophy
  3. Inferior MI
  4. Left Anterior Fascicular Block
  5. Primum ASD*